Internal Medicine Commons^™

A Rare Presentation Of Hsv Type 2 Hepatitis., Jahangir Khan Md, Anam Malik Md, Sandhya Venkataraman Do, Hina A. Sheikh, Amy Slenker Md

Hina A. Sheikh, M.D.

No abstract provided.

Ammonia Vs. Lactic Acid In Predicting Positivity Of Microbial Culture In Sepsis: The Alps Pilot Study, Yazan Numan, Yasir Jawaid, Hisham Hirzallah, Damir Kusmic, Mohammed Megri, Obadah Aqtash, Ahmed Amro, Haitem Mezughi, Emmon Maher, Yonas Raru, Jamil Numan, Sutoidem Akpanudo, Zeid Khitan, Yousef Shweihat

Zeid J. Khitan

Objective: The use of serum ammonia as a novel marker for sepsis compared to lactic acid levels in intensive care unit (ICU) patients.

Design and Interventions: Single arm, prospective clinical trial to collect arterial blood samples from patients with sepsis. Serial ammonia and lactic acid levels were sent every six hours for a total of three days.

Measurements and results: Compare mean levels of ammonia and lactic acid in terms of diagnosing sepsis and patient outcome, including length of stay and mortality. A total of 30 patients were enrolled in the pilot study. On admission, mean ammonia level was 35.7 …

Ammonia Vs. Lactic Acid In Predicting Positivity Of Microbial Culture In Sepsis: The Alps Pilot Study, Yazan Numan, Yasir Jawaid, Hisham Hirzallah, Damir Kusmic, Mohammed Megri, Obadah Aqtash, Ahmed Amro, Haitem Mezughi, Emmon Maher, Yonas Raru, Jamil Numan, Sutoidem Akpanudo, Zeid Khitan, Yousef Shweihat

Sutoidem Akpanudo

Objective: The use of serum ammonia as a novel marker for sepsis compared to lactic acid levels in intensive care unit (ICU) patients.

Design and Interventions: Single arm, prospective clinical trial to collect arterial blood samples from patients with sepsis. Serial ammonia and lactic acid levels were sent every six hours for a total of three days.

Measurements and results: Compare mean levels of ammonia and lactic acid in terms of diagnosing sepsis and patient outcome, including length of stay and mortality. A total of 30 patients were enrolled in the pilot study. On admission, mean ammonia level was 35.7 …

Massive Hemoptysis Due To Recurrence Of Bronchial To Pulmonary Vascular Malformation: A Case Report, Chelsey White, Pedro Ottaviano, Nancy Munn, Yousef Shweihat, Fuad Zeid

Fuad M. Zeid

Bronchial dieulafoy lesions are quite rare with relatively few case reports in the literature. Symptoms may vary but the lesion is often associated with hemoptysis and may present as massive hemoptysis. We present a case of a 69-year-old male with a recurrent episode of hemoptysis three years after treatment for a bronchial dieulafoy lesion. The bronchoscopy done three years prior during an initial episode of hemoptysis showed a visible dieulafoy deep within a subsegmental branch of the right lower lobe. This case is unique because there are no other reports within the literature of a delayed recurrence several years after …

A Rare Case Of Metastases From A High-Grade Astrocytoma To The Pleura, Bones, And Liver Within Six Months Of Diagnosis, Jennifer L. Dotson, Ala Nijim, Krista L. Denning, Yousef R. Shweihat, Yehuda Lebowicz

Yehuda Z. Lebowicz, MD

High grade astrocytomas such as anaplastic astrocytoma and glioblastoma multiforme are aggressive central nervous system malignancies with a poor prognosis. Due to shortened survival times, their devastating effects are usually localized intracranially and rarely metastasize outside of the central nervous system. When metastases occur, they usually present in patients with longer survival times and they typically coincide with a primary site recurrence. We present a rare case of metastases from a high-grade astrocytoma/glioblastoma to the pleura, bones and liver within six months of diagnosis, without primary site recurrence.

A Rare Case Of Metastases From A High-Grade Astrocytoma To The Pleura, Bones, And Liver Within Six Months Of Diagnosis, Jennifer L. Dotson, Ala Nijim, Krista L. Denning, Yousef R. Shweihat, Yehuda Lebowicz

Krista L. Denning

High grade astrocytomas such as anaplastic astrocytoma and glioblastoma multiforme are aggressive central nervous system malignancies with a poor prognosis. Due to shortened survival times, their devastating effects are usually localized intracranially and rarely metastasize outside of the central nervous system. When metastases occur, they usually present in patients with longer survival times and they typically coincide with a primary site recurrence. We present a rare case of metastases from a high-grade astrocytoma/glioblastoma to the pleura, bones and liver within six months of diagnosis, without primary site recurrence.

Case Report: Steroid Responsive Mesothelioma-Related Pleural Effusion, Mena Shehata, Fouad Zaid, Peter Ottaviano, Yousef Shweihat, Nancy Munn

Peter Ottaviano

Malignant pleural mesothelioma (MPM) is an asbestos-related tumor arising in the pleural cavity. Symptoms reflect extension of disease and include shortness of breath and chest pain. Unexplained pleural effusion and pleural pain in patients exposed to asbestos should raise the suspicion of MPM. The most common radiologic presentation is ipsilateral pleural effusion with or without pleural thickening or a mass. Thoracoscopic biopsy remains the most appropriate procedure for definitive diagnosis of mesothelioma. Despite advancement in diagnostic procedures and biomolecular research, this tumor nevertheless has poor prognosis. Mesothelioma remains a diagnostic and therapeutic challenge and is likely to remain one in …

Massive Hemoptysis Due To Recurrence Of Bronchial To Pulmonary Vascular Malformation: A Case Report, Chelsey White, Pedro Ottaviano, Nancy Munn, Yousef Shweihat, Fuad Zeid

Peter Ottaviano

Bronchial dieulafoy lesions are quite rare with relatively few case reports in the literature. Symptoms may vary but the lesion is often associated with hemoptysis and may present as massive hemoptysis. We present a case of a 69-year-old male with a recurrent episode of hemoptysis three years after treatment for a bronchial dieulafoy lesion. The bronchoscopy done three years prior during an initial episode of hemoptysis showed a visible dieulafoy deep within a subsegmental branch of the right lower lobe. This case is unique because there are no other reports within the literature of a delayed recurrence several years after …

Pembrolizumab Reactivates Pulmonary Granulomatosis, Majdi Al-Dliw, Mohammed Megri, Ibrahim M. Shahoub, Gaurav Sahay, Teresa I. Limjoco, Yousef Shweihat

Teresa Limjoco

Sarcoid like reaction is a well-known entity that occurs as a consequence to several malignancies or their therapies. Immunotherapy has gained a lot of interest in the past few years and has recently gained approval as first line therapy in multiple advanced stage malignancies. Pneumonitis has been described as complication of such therapy. Granulomatous inflammation has been only rarely reported subsequent to immunotherapy. We describe a case of granulomatous inflammation reactivation affecting the lungs in a patient previously exposed to Pembrolizumab and have evidence of a distant granulomatous infection. We discuss potential mechanisms of the inflammation and assert the importance …

The Role And Safety Of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration In The Diagnosis And Management Of Infected Bronchogenic Mediastinal Cysts In Adults, Hazim S. Bukamur, Emad Alkhankan, Haitem Mezughi, Nancy J. Munn, Yousef R. Shweihat

Yousef R. Shweihat

Bronchogenic and other duplication cysts are congenital abnormalities that can present at any age including adulthood years. They are usually asymptomatic and discovered incidentally on radiological imaging of the chest. They are commonly treated by surgical resection. Recently, endobronchial ultrasound has been used to assist in diagnosis when radiologic imaging is not definitive. Endobronchial ultrasound has been used rarely to drain infected cysts, a rare complication of the bronchogenic cyst. We present a unique case of an infected large bronchogenic cyst treated with endobronchial ultrasound drainage combined with conservative medical therapy. We also review the scarce available literature describing such …

Pembrolizumab Reactivates Pulmonary Granulomatosis, Majdi Al-Dliw, Mohammed Megri, Ibrahim M. Shahoub, Gaurav Sahay, Teresa I. Limjoco, Yousef Shweihat

Yousef R. Shweihat

Sarcoid like reaction is a well-known entity that occurs as a consequence to several malignancies or their therapies. Immunotherapy has gained a lot of interest in the past few years and has recently gained approval as first line therapy in multiple advanced stage malignancies. Pneumonitis has been described as complication of such therapy. Granulomatous inflammation has been only rarely reported subsequent to immunotherapy. We describe a case of granulomatous inflammation reactivation affecting the lungs in a patient previously exposed to Pembrolizumab and have evidence of a distant granulomatous infection. We discuss potential mechanisms of the inflammation and assert the importance …

The Role And Safety Of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration In The Diagnosis And Management Of Infected Bronchogenic Mediastinal Cysts In Adults, Hazim S. Bukamur, Emad Alkhankan, Haitem Mezughi, Nancy J. Munn, Yousef R. Shweihat

Nancy J. Munn

Bronchogenic and other duplication cysts are congenital abnormalities that can present at any age including adulthood years. They are usually asymptomatic and discovered incidentally on radiological imaging of the chest. They are commonly treated by surgical resection. Recently, endobronchial ultrasound has been used to assist in diagnosis when radiologic imaging is not definitive. Endobronchial ultrasound has been used rarely to drain infected cysts, a rare complication of the bronchogenic cyst. We present a unique case of an infected large bronchogenic cyst treated with endobronchial ultrasound drainage combined with conservative medical therapy. We also review the scarce available literature describing such …

Pneumonia Due To A Rare Pathogen: Achromobacter Xylosoxidans, Subspecies Denitrificans, Hesham Awadh, Munthir Mansour, Obadah Aqtash, Yousef Shweihat

Yousef R. Shweihat

Achromobacter xylosoxidans, subspecies denitrificans, is a gram-negative rod recently implicated as an emerging cause of infection in both immunosuppressed and immunocompetent populations. Few cases are reported in literature involvingmultiple body systems. Diagnosis depends on cultures of appropriate specimens, and management usually is by administration of appropriate antibiotics(usually agents with antipseudomonal activity).We report a rare case of pneumonia due to infection with this organism, in a patient with preexisting bronchiectasis secondary to chronic aspiration.

Bronchopleural Fistula Resolution With Endobronchial Valve Placement And Liberation From Mechanical Ventilation In Acute Respiratory Distress Syndrome: A Case Series, Haris Kalatoudis, Nikhil Meena, Fuad Zeid, Yousef Shweihat

Yousef R. Shweihat

Patients who have acute respiratory distress syndrome (ARDS) with persistent air leaks have worse outcomes. Endobronchial valves (EBV) are frequently deployed after pulmonary resection in noncritically ill patients to reduce and eliminate bronchopleural fistulas (BPFs) with persistent air leak (PAL). Information regarding EBV placement in mechanically ventilated patients with ARDS and high volume persistent air leaks is rare and limited to case reports. We describe three cases where EBV placement facilitated endotracheal extubation in patients with severe respiratory failure on prolonged mechanical ventilation with BPFs. In each case, EBV placement led to immediate resolution of PAL. We believe endobronchial valve …

Bronchopleural Fistula Resolution With Endobronchial Valve Placement And Liberation From Mechanical Ventilation In Acute Respiratory Distress Syndrome: A Case Series, Haris Kalatoudis, Nikhil Meena, Fuad Zeid, Yousef Shweihat

Fuad M. Zeid

Patients who have acute respiratory distress syndrome (ARDS) with persistent air leaks have worse outcomes. Endobronchial valves (EBV) are frequently deployed after pulmonary resection in noncritically ill patients to reduce and eliminate bronchopleural fistulas (BPFs) with persistent air leak (PAL). Information regarding EBV placement in mechanically ventilated patients with ARDS and high volume persistent air leaks is rare and limited to case reports. We describe three cases where EBV placement facilitated endotracheal extubation in patients with severe respiratory failure on prolonged mechanical ventilation with BPFs. In each case, EBV placement led to immediate resolution of PAL. We believe endobronchial valve …

Esophageal Diagnosis Of A Malignant Aspergilloma, Muneer Al Zoby, Nancy Munn,, Yousef Shweihat

Nancy J. Munn

A 59-year-old male patient developed a new 4 cm × 6 cm cavitary left upper lung lesion over a 2 months period. The patient had a prior history of a surgically resected Stage IA non-small cell lung cancer in the right upper lobe 3 years prior. He was treated for possible infection with radiographic improvement on subsequent imaging. Further imaging after 3 months revealed an oval soft tissue density within the cavity with air crescent sign. Bronchoscopy with transbronchial biopsies showed an acute and chronic granulomatous inflammation. Aspergillus fumigatus was noted on culture and voriconazole was initiated. Subsequent imaging showed …

Severe Pneumomediastinum Complicating Ebus-Tbna, Yousef Shweihat, James D. Perry Iii, Nancy Munn

Nancy J. Munn

Pneumomediastinum infrequently complicates diagnostic bronchoscopy. Increased airway or alveolar pressure results in air leaks to the mediastinum through existing or induced defects. Excessive cough, recurrent episodes of increased abdominal pressure, vomiting, or sneezing can all induce spontaneous pneumomediastinum. Less commonly it has been documented with lung or neck infections, esophageal or tracheal tears, and rapid increases in altitude such as during plane flights or scuba diving, with mechanical ventilation, substance abuse, and after bronchoscopy. Pneumomediastinum may be, but is not always, associated with pneumothorax.

Severe Pneumomediastinum Complicating Ebus-Tbna, Yousef Shweihat, James D. Perry Iii, Nancy Munn

Yousef R. Shweihat

Pneumomediastinum infrequently complicates diagnostic bronchoscopy. Increased airway or alveolar pressure results in air leaks to the mediastinum through existing or induced defects. Excessive cough, recurrent episodes of increased abdominal pressure, vomiting, or sneezing can all induce spontaneous pneumomediastinum. Less commonly it has been documented with lung or neck infections, esophageal or tracheal tears, and rapid increases in altitude such as during plane flights or scuba diving, with mechanical ventilation, substance abuse, and after bronchoscopy. Pneumomediastinum may be, but is not always, associated with pneumothorax.

Is Chest Tube Insertion With Ultrasound Guidance Safe In Patients Using Clopidogrel?, Wissam Abouzgheib, Yousef R. Shweihat, Nikhil Meena, Thaddeus Barrter

Yousef R. Shweihat

Background and objective: Drainage of the pleural space is a common procedure.The safety of chest tube insertion in patients using clopidogrel has not been investigated.

Methods: Ultrasound-guided chest tube insertions performed on 24 patients who were being actively treated with clopidogrel were retrospectively reviewed.

Results: No excessive bleeding occurred in any of these patients.

Conclusions: Given the known effects of clopidogrel on platelet function, these results were interpreted as indicating that clopidogrel therapy is a relative but not an absolute contraindication to chest tube insertion, if an experienced operator places a small-bore tube under ultrasound guidance.

Esophageal Diagnosis Of A Malignant Aspergilloma, Muneer Al Zoby, Nancy Munn,, Yousef Shweihat

Yousef R. Shweihat

A 59-year-old male patient developed a new 4 cm × 6 cm cavitary left upper lung lesion over a 2 months period. The patient had a prior history of a surgically resected Stage IA non-small cell lung cancer in the right upper lobe 3 years prior. He was treated for possible infection with radiographic improvement on subsequent imaging. Further imaging after 3 months revealed an oval soft tissue density within the cavity with air crescent sign. Bronchoscopy with transbronchial biopsies showed an acute and chronic granulomatous inflammation. Aspergillus fumigatus was noted on culture and voriconazole was initiated. Subsequent imaging showed …

Gender Differences In Takotsubo Cardiomyopathy As A Secondary Diagnosis: Higher Hospital Charges, More Procedures, And Longer Length Of Stays, Daniel Eric Westerdahl, Hsin-Fang Li, Amir Yazdani, Kateri Spinelli, Tyler Gluckman

Tyler J. Gluckman, MD, FACC, FAHA

Differential Impact Of Bleeding Avoidance Strategies On Risk-Adjusted Pci-Related Bleeding Rates Within A Large Multistate Health System, Tyler J. Gluckman, Kateri Spinelli, Lian Wang, John Petersen, Paul P. Huang, Sunil Rao

Tyler J. Gluckman, MD, FACC, FAHA

Limiting Antibiotic Use In Acute Sinusitis: Partly A Matter Of Vocabulary?, Dennis J. Baumgardner

Dennis J. Baumgardner, MD

In his issue introduction, the editor-in-chief of Journal of Patient-Centered Research and Reviews comments on an included article that describes the successful use of an electronic medical record best practice alert to reduce the rate of antibiotic prescription for acute sinusitis. Various methods previously tried to improve antibiotic stewardship in this illness are briefly reviewed. Borrowing on the model of acute bronchitis, it is suggested that a change in conveyed diagnostic vocabulary to “sinus cold” when describing acute sinusitis may help limit antibiotics for this predominantly viral infection.

Is Engagement Alone Sufficient To Ensure “Active Learning”?, Reed Krause, Amy C. Hayton Md, Jeff Wonoprabowo, Lawrence Loo

Amy Hayton, MD

“Active Learning” is commonly defined as any instructional method that engages students in the learning process. However, active learning encompasses a broad range of educational methods and its impact on learning outcomes has been variable. In 2015, our IM clerkship redesigned its half-day learning sessions from a largely passive didactic style of lecturing to more active learning approaches. We further revised the curriculum in 2016 to further convert the sessions to primarily case based learning led by a faculty or resident. The goal of our intervention was to increase the Self-Reported Engagement Measure (STOBE) of each didactic session and improve …

Does Ecg And Arrhythmia Simulation Training In Adjunct To Didactics Improve Medical Students’ Clinical Skills Compared To Didactics Alone?, Reed Krause, Amy C. Hayton Md

Amy Hayton, MD

Medical Schools continue to face the challenge of bridging the gap between classroom education and its application in the clinical environment. Several studies have shown utility of incorporating simulation training into a variety of healthcare related topics. We hypothesize that incorporating ECG and arrhythmia simulation training in adjunction to ECG and arrhythmia didactics; it would improve Year-3 medical students’ preparedness for managing arrhythmias in the clinical setting.

Dementia Care: Confronting Myths In Clinical Management, Shirley M. Neitch Md, Charles Meadows Md, Eva Patton-Tackett Md, Kevin W. Yingling Md

Kevin W. Yingling

Enormous challenges of this pervasive life-changing condition. Seeking help, often grasping at straws, victims, and their care providers are confronted with misinformation and myths when they search the internet or other sources. When Persons with Dementia (PWD) and their caregivers believe and/or act on false information, proper treatment may be delayed, and ultimately damage can be done. In this paper, we review commonly misunderstood issues encountered in caring for PWD. Our goal is to equip Primary Care Practitioners (PCPs) with accurate information to share with patients and families, to improve the outcomes of PWD to the greatest extent possible.

While …

Dementia Care: Confronting Myths In Clinical Management, Shirley M. Neitch Md, Charles Meadows Md, Eva Patton-Tackett Md, Kevin W. Yingling Md

Shirley M. Neitch

Enormous challenges of this pervasive life-changing condition. Seeking help, often grasping at straws, victims, and their care providers are confronted with misinformation and myths when they search the internet or other sources. When Persons with Dementia (PWD) and their caregivers believe and/or act on false information, proper treatment may be delayed, and ultimately damage can be done. In this paper, we review commonly misunderstood issues encountered in caring for PWD. Our goal is to equip Primary Care Practitioners (PCPs) with accurate information to share with patients and families, to improve the outcomes of PWD to the greatest extent possible.

While …

Development Of A Health Care Systems Curriculum., Zachary Pruitt, Rahul Mhaskar, Bryan G. Kane Md, Robert D. Barraco Md, Mph, Deborah J Dewaay, Alexander M. Rosenau Do, Kristin A. Bresnan Md, Marna R. Greenberg Do, Mph, Facep

Marna R Greenberg DO, MPH, FACEP

Background: There is currently no gold standard for delivery of systems-based practice in medical education, and it is challenging to incorporate into medical education. Health systems competence requires physicians to understand patient care within the broader health care system and is vital to improving the quality of care clinicians provide. We describe a health systems curriculum that utilizes problem-based learning across 4 years of systems-based practice medical education at a single institution.

Methods: This case study describes the application of a problem-based learning approach to system-based practice medical education. A series of behavioral statements, called entrustable professional activities, was created …

Development Of A Health Care Systems Curriculum., Zachary Pruitt, Rahul Mhaskar, Bryan G. Kane Md, Robert D. Barraco Md, Mph, Deborah J Dewaay, Alexander M. Rosenau Do, Kristin A. Bresnan Md, Marna R. Greenberg Do, Mph, Facep

Bryan G Kane MD

Background: There is currently no gold standard for delivery of systems-based practice in medical education, and it is challenging to incorporate into medical education. Health systems competence requires physicians to understand patient care within the broader health care system and is vital to improving the quality of care clinicians provide. We describe a health systems curriculum that utilizes problem-based learning across 4 years of systems-based practice medical education at a single institution.

Methods: This case study describes the application of a problem-based learning approach to system-based practice medical education. A series of behavioral statements, called entrustable professional activities, was created …

Discrepancies In Publications Related To Hmb-Fa And Atp Supplementation, Jeremy A. Gentles, Stuart M. Phillips

Jeremy A. Gentles